MEDICARE: BEVERLY RADIOLOGY MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ03078Z	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1962456129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEVERLY RADIOLOGY MEDICAL GROUP

Provider Business Mailing Address
First Line	:	PO BOX 240086
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-9186
Country	:	US
Telephone Number	:	626-966-1580
Fax Number	:	626-967-7821

Provider Business Practice Location Address
First Line	:	10101 RIVERSIDE DR
Second Line	:
City	:	TOLUCA LAKE
State	:	CA
Zip	:	91602-2517
Country	:	US
Telephone Number	:	818-762-2626
Fax Number	:	818-762-0288

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HOWARD G BERGER
Credential	:	MD
Telephone Number	:	310-445-2800

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	08/22/2020

Similar Medicare Providers

1679403224 — TIMENA WILSON
Practice Location Address:

2517 LAKE MARTIN CT
NORTH LAS VEGAS, NV
89031-4306

Practice Phone: 707-980-9485
Practice Fax:

1104756758 — TYLER IMANI-BENET MOORE PCA
Practice Location Address:

2517 LAKE MARTIN CT
NORTH LAS VEGAS, NV
89031-4306

Practice Phone: 925-219-6154
Practice Fax:

1770668337 — RICHARD MAW MD PC
Practice Location Address:

2517 E LAKE MEAD BLVD
NORTH LAS VEGAS, NV
89030-6410

Practice Phone: 702-642-7711
Practice Fax: 702-642-8822

1598840134 — EYE & COSMETIC SURGERY CENTER OF NEVADA, LLC
Practice Location Address:

2517 E LAKE MEAD BLVD
NORTH LAS VEGAS, NV
89030-6410

Practice Phone: 702-642-7711
Practice Fax: 702-642-8822

1780769331 — RICHARD J MAW M.D.
Practice Location Address:

2517 E LAKE MEAD BLVD
NORTH LAS VEGAS, NV
89030-6410

Practice Phone: 702-642-7711
Practice Fax: 702-642-8822

1467521112 — PETER ANDREW DANZIG LCSW
Practice Location Address:

1610 W 500 N
SALT LAKE CITY, UT
84116-2517

Practice Phone: 801-865-9029
Practice Fax:

Directions to “BEVERLY RADIOLOGY MEDICAL GROUP ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.